Somatic Symptoms In Patients Research Articles

Effects of Transcranial Direct Current Stimulation Targeting Dorsolateral Prefrontal Cortex and Orbitofrontal Cortex on Somatic Symptoms in Patients With Major Depressive Disorder: A Randomized, Double-Blind, Controlled Clinical Trial.

There is a lack of research on transcranial direct current stimulation (tDCS) for the treatment of somatic symptoms in major depressive disorder (MDD) and the suitable stimulating brain region. We investigated the efficacy of tDCS targeting the dorsolateral prefrontal cortex (DLPFC) versus orbitofrontal cortex (OFC) on depressive somatic symptoms and somatic anxiety in patients with MDD and aimed to identify the appropriate stimulating brain regions. In this randomized, double-blind, sham-controlled study, a total of 70 patients diagnosed with MDD were randomly allocated into DLPFC group, OFC group, and Sham group. Subjects participated in 2 weeks of 10 primary interventions and subsequently 2-week maintenance interventions weekly (20 min, 2 mA). The DLPFC group showed a more significant improvement in somatic symptoms compared to the Sham group at week 2. At the maintenance and follow-up stages, the DLPFC group outperformed the Sham and OFC groups, but the difference with the Sham group was not significant. Neither active group demonstrated superiority over the Sham group in improving depression and anxiety. In conclusion, the tDCS targeting DLPFC may be a potentially effective therapeutic target for alleviating somatic symptoms in patients with MDD.

Characteristics and predictors of persistent somatic symptoms in patients with cardiac disease

Persistent somatic symptoms (PSS) are a diagnostic core criterion of the somatic symptom disorder. This longitudinal study aims to determine the frequency of PSS in patients with cardiac disease, identify potential predictive factors, and investigate its impact on healthcare utilization. Somatic symptoms were assessed with the Somatic Symptom Scale-8 four times over the course of three months in consecutively approached cardiac outpatients. Patients were grouped having PSS vs. not having PSS following a psychometric-driven approach based on the SSS-8 cut-off score and a data-driven approach applying cluster analysis. T-tests were performed to compare the characteristics between patients having vs. not having PSS. To identify predictors of group affiliation, we conducted multivariable logistic regressions. Additionally, analyses of covariance were used to further examine associations between healthcare utilization and group affiliation. The study included 95 patients (30.5% female) with a mean age of 60.5 years (SD = 8.7). All patients had at least one of the following cardiac diseases recorded in their medical history: coronary heart disease (n = 51), myocardial infarction (n = 21), valve disease (n = 22), cardiomyopathy (n = 15), cardiac dysrhythmia (n = 43), and heart failure (n = 12). 30 (32%) were grouped having PSS according to the psychometric-driven approach and 27 (28%) according to the data-driven approach. For both approaches, patients with PSS were more likely to be female, unemployed, reporting angina pectoris, having higher depression, and higher anxiety severity (for all: p ≤ 0.05). Predictors of PSS group affiliation were female gender, higher age, depression severity, and angina pectoris (for all: p ≤ 0.015). Patients with PSS more frequently visited general practitioners and cardiologists compared to patients without PSS (p ≤ 0.013). Enhancing our knowledge of PSS in patients with cardiac disease could help to improve identification of patients’ specific needs and the factors to consider in diagnosis and individualized treatment.

“It’s a Psychiatric Patient”: Misdiagnosing of Somatic Symptoms in Patients with Mental Disorders Due to Stigma and Inadequate Diagnostic Treatment

Aim: People with mental illness have more somatic comorbidities and are frequently mistreated. Misdiagnosis occurs for a variety of reasons, including stigma, poor communication, lack of knowledge of psychiatric pathology, and a tendency to attribute physical symptoms to a mental disorder. Case report: The factors listed above, as well as the unique circumstances of the COVID-19 pandemic led to the misdiagnosis in the case discussed in this paper. The patient was a middle-aged man diagnosed with an ICD-10 diagnosis of a chronic mental disorder in the F2 category and multiple somatic comorbidities in whom amiodarone-induced thyrotoxicosis was undiagnosed and somatic symptoms were attributed to antipsychotic-induced parkinsonism. The mechanism of amiodarone-induced thyrotoxicosis and antipsychotic-induced extrapyramidal symptoms will be described, together with the factors that caused our patient to be misdiagnosed. Conclusion: Psychiatric patients are often specific in their communication and behaviour, therefore interaction must be adapted, with a focus on destigmatizing and educating health workers.

The impact of COVID-19 mRNA vaccination on somatic and psychiatric symptoms in patients with treatment-resistant schizophrenia: a cohort study

IntroductionPatients with mental illness, particularly those with treatment-resistant schizophrenia, are at increased risk of severe COVID-19. The protective effect of vaccination against severe disease has been demonstrated, and vaccination of vulnerable individuals was a priority during the vaccination campaign. However, the effect of vaccination on the psychiatric symptoms of the disease is not well understood.ObjectivesTo investigate the impact of COVID-19 vaccination on psychiatric symptoms and somatic symptoms in patients hospitalized for treatment-resistant schizophrenia.MethodsThirty patients hospitalized for treatment-resistant schizophrenia with a history of medico-legal acts were admitted to the forensic psychiatry department at Razi Hospital in Manouba, Tunisia. The consent of patients and/or their relatives was obtained before vaccination, and potential side effects were explained to patients and their families. A neuropsychiatric assessment and clinical examination of patients were performed by their referring psychiatrist before vaccination and one month after.ResultsThe patients were all male, with a mean age of 42.3 years.No patient had an allergic reaction to the vaccine. No patient was infected with the virus one month after vaccination. On the clinical level, 30% of patients had general symptoms such as fatigue and myalgia, which improved spontaneously within a few days. On the psychiatric level, exacerbation of positive symptoms such as hallucinations and delusions was found in 26% of patients. No increase in the frequency of agitation episodes or risk of hetero-aggressive behavior was reported. Sleep disturbances such as difficulty falling asleep and fragmented sleep were reported. The most common functional complaints reported by patients were palpitations, which were a source of somatic concern.ConclusionsSeveral side effects of the vaccine have been documented and are taken into account in the daily practice of practitioners, but psychiatric effects are poorly reported and are sometimes attributed to the underlying disease. A complete examination, objective assessment, and regular follow-up are necessary to identify symptoms early and prevent relapses.Because of the small size of the sample;results could not be generelized.Further studies on a larger scale should be conducted.Disclosure of InterestNone Declared

Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

Patients with induced laryngeal obstruction (ILO) present with a variety of behavioral health profiles. Identifying these profiles is crucial in that behavioral health conditions may affect treatment duration and outcomes. To characterize the prevalence of anxiety, depression, posttraumatic stress disorder (PTSD), and physical somatic symptoms in adult and pediatric patients with ILO and determine the factors associated with anxiety, depression, PTSD, and physical somatic symptoms in patients with ILO? This cross-sectional study included a nonprobability sample of 83 adult and 81 pediatric patients diagnosed with ILO at outpatient adult and pediatric otolaryngology clinics between 2021 and 2023. Exclusion criteria included a comorbid respiratory diagnosis other than asthma, head or neck cancer, or neurological impairments. Recruitment took place between September 2021 and March 2023. The analyses were run in January 2024. Patients were prospectively screened for anxiety, depression, PTSD, and somatic physical symptoms. In addition, any past behavioral health diagnoses were extracted from the medical record. Comorbidities, ILO symptoms triggers, and onset details were gathered from ILO evaluations. Adult patients completed the Screen for Adult Anxiety Related Disorders (SCAARED), depression (Patient Health Questionnaire [PHQ]-9), and somatic physical symptoms portions of the Patient Health Questionnaires (PHQ-15), and the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5). Pediatric patients completed the Screen for Child Anxiety Related Disorders (SCARED), depression (PHQ-9A) and somatic physical symptoms portions of the Patient Health Questionnaires for Adolescents (PHQ-15A), and the UCLA PTSD Reaction Index brief screeners. Eighty-three adult patients participated in this study (mean [SD] age, 45.8 [14.3] years; 64 female, 19 male). Eighty-one pediatric patients participated (mean [SD] age, 13.83 [2.55] years; 67 female, 14 male). Adult and pediatric patients with ILO screened positive for elevated rates of anxiety (53 adults [63%]; 49 children [60%]), depression (27 adults [32%]; 25 children [30%]), and PTSD (29 adults [34%]; 13 children [16%]). Most of the patients with anxiety and depression symptoms were formally diagnosed prior to ILO evaluation, with rates of previously diagnosed anxiety, depression, and PTSD also above published norms. Adults were twice as likely as children to present with PTSD (odds ratio, 2.1; 95% CI, 0.05-4.48). Elevated rates of physical somatic symptoms were also evident, with 38 adults (45%) and 32 children (39%) scoring in the moderate to severe range. This study found high rates of adult and pediatric patients with ILO screened positive for anxiety, depression, and PTSD symptoms. Future work should investigate how behavioral health and ILO treatments can best be coordinated to maximize treatment outcomes.

Effect of Soft Tissue Mobilisation on Somatic Symptoms in Chronic Low Back Pain Patients: A Pilot Pretest Post-test Randomised Clinical Trial

Introduction: Numerous studies suggest a significant correlation between Chronic Low Back Pain (CLBP) and somatic symptoms. These symptoms often stem from altered fascial biomechanics. Implementing Soft Tissue Mobilisation (STM) techniques aimed at restoring fascial biomechanics can markedly alleviate somatic symptoms associated with CLBP. Aim: To assess the efficacy of STM in alleviating somatic symptoms in patients with Chronic Low Back Pain (CLBP). Materials and Methods: A pilot pretest post-test randomised clinical trial was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, from July 2023 to December 2023, on participants diagnosed with Non Specific Chronic Low Back Pain (NSCLBP) accompanied by somatic symptoms. The experimental group (Group 1), n=6 (41.00±6.29 years), received myofascial unwinding and myofascial release. In contrast, the clinical group (Group 2), n=6 (43.83±11.20 years), received conventional physiotherapy care, including structured exercises and electrophysical modalities, over 4 weeks. Both groups underwent three sessions per week, amounting to 12 sessions in total. The evaluation of somatic symptoms was conducted using the Hamilton Depression Rating Scale (HDRS) at baseline and after the 4 weeks. Results: The statistical analysis demonstrated significant withingroup differences in HDRS (p-value=0.002) in Group 1, and no statistically significant difference in Group 2 (p-value=0.749). The between-group analysis demonstrated a statistically significant difference in HDRS (p=0.035) with a large effect size (d=1.4). Conclusion: STM effectively improves somatic symptoms in NSCLBP patients. The beneficial effect of STM on somatic symptoms can be translated into clinical practice after strengthening results in the larger population.

Serum BDNF levels and state anxiety are associated with somatic symptoms in patients with panic disorder.

We aimed to explore the predictive role of serum BDNF and anxiety-related variables in changes in somatic symptoms post-escitalopram treatment in panic disorder (PD) patients. Ninety PD patients and 99 healthy controls (HCs) were enrolled. PD patients received an 8-week escitalopram treatment. All patients were administered the Panic Disorder Severity Scale-Chinese Version (PDSS-CV) and State-Trait Anxiety Inventory (STAI) to assess panic and anxiety-related symptoms, respectively. Patient Health Questionnaire 15-item scale (PHQ-15) was performed to measure somatic symptoms, and the blood sample was collected to detect serum BDNF levels in all participants. We performed partial correlation analysis and multiple linear regression to explore correlates of PHQ-15 and predictors of PHQ-15 changes post-escitalopram treatment after controlling for age, gender, education levels (set as a dummy variable), the current duration, comorbid AP, and/or GAD. Compared to HCs, PD patients had lower serum BDNF levels and higher PHQ-15 scores that could be improved post-escitalopram treatment. Lower baseline STAI state (b = -0.07, p = 0.004), and PDSS-CV scores (b = -0.25, p = 0.007), but higher baseline serum BDNF levels (b = 0.35, p = 0.007) contributed to the prediction of PHQ-15 changes post-escitalopram treatment. State anxiety, serum BDNF levels, and panic severity could predict changes in somatic symptoms post-escitalopram treatment, our results highlighted that serum BDNF could serve as a biological indicator for improving somatic symptoms in PD patients.

Somatic symptoms in schizophrenia: Association with socio-demographic and clinical characteristics, disability and quality of life.

There is lack of research on somatic symptoms in schizophrenia. We aimed at finding prevalence and types of somatic symptoms in patients with schizophrenia and assessed their association with socio-demographic and clinical characteristics. We assessed somatic symptoms using Patient Health Questionnaire-15 (PHQ-15) in 93 patients with schizophrenia diagnosed on ICD10-DCR. Scale for Assessment of Positive Symptoms and Scale for Assessment of Negative Symptoms, WHO Disability Assessment Schedule 2.0, WHO Quality of Life (BREF) Hindi version and Liverpool University Neuroleptic Side-Effect Rating Scale were used to assess psychopathology, disability, quality of life and side effects. Significant somatic symptoms (n ≥5 on PHQ-15) were present in 62 (67.7%) patients with schizophrenia. Forty three (69.4%) had mild (n = 5-9 on PHQ-15), 17 (27.4%) had moderate (n = 10-14 on PHQ-15), and only 2 (3.2%) had severe (n = ≥15 on PHQ -15) somatic symptoms. Mean somatic symptoms score on PHQ-15 was 7.28 (± 3.83); 96.8% reported feeling tired, 76.3% had constipation or diarrhoea, 67.7% trouble in sleeping, 61.3% nausea or indigestion, 52.7% back pain and 51.6% headache. Patients with somatic symptoms were older in age, had longer duration of illness and treatment, and had more negative symptoms. They had higher disability and poor quality of life especially in physical domain. Somatic symptoms are common in patients with schizophrenia and are associated with chronicity, refractoriness and negative symptoms, significant disability and poor quality of life. Thus during routine clinical practice, somatic symptoms should be assessed and managed in these patients.

Nil per os duration and anxiety: A single center cross-sectional study

IntroductionPreoperative fasting prior to general anesthesia or sedation is utilized to reduce the risk of aspiration and the severity of the pulmonary sequelae should aspiration occur. Consensus fasting guidelines are established, however, existing data indicates that patients continue to fast significantly longer than is recommended prior to surgery. The aim of this study was to understand the true preoperative solid and clear liquid fasting durations and its concomitant effect on somatic symptoms in patients undergoing surgery at a large tertiary care medical center. MethodsAmbulatory patients scheduled for elective procedures were enrolled during pre-surgical testing or on the day of surgery. Standard ASA fasting guideline base instructions were given to patients during their in-person pre-surgical testing visit. Subject participation required a brief in-person questionnaire prior to surgery. Patients were divided into morning, afternoon or evening groups and a one-way ANOVA was performed to compare mean fasting times. ResultsThree-hundred-and-ninety-nine patients completed the survey. 95% (n = 379) of patients indicated that fasting instructions were clear prior to surgery; 4.76% (n = 19) recalled being told they could drink clear liquids up to two hours before surgery. Average fasting time for solids and clear liquids was 16.13 and 14.95 h. Mean solid fasting durations were 11.55, 15.03, and 17.73 h (p < 0.0001) and clear liquids fast durations were 10.00, 14.05, 16.80 h (p < 0.0001) for morning, afternoon and evening cases, respectively. Female patients and those reporting hunger and thirst preoperatively were more likely to report moderate to severe anxiety preoperatively (p = 0.007, p = 0.0002, p < 0.0001). ConclusionDespite universal guidelines advocating for decreased fasting practices, nil per os times remain significantly prolonged. Preoperative anxiety is associated with prolonged solid and liquid fasting duration.

Sex differences in residual somatic symptoms in patients with first-episode depression after acute-phase treatment

BackgroundResidual somatic symptoms (RSS) are common in depressed patients, predicting treatment effectiveness. However, sex differences in RSS have received little systematic study. This study was conducted to compare sex differences of RSS in patients with first-episode depression (FED).MethodsNine hundred eighty-two patients with FED were selected and treated for 8 to 12 weeks. We evaluated the subjects' socio-demographic characteristics and residual depressive symptoms. Using the Patient Health Questionnaire-15 (PHQ-15) scale to assess residual somatic symptoms, the Sheehan Disability Scale (SDS) for the assessment of patients' function, the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) for quality of life.ResultsThe incidence of RSS with FED was 46.4%. For patients with residual symptoms, the age and age of onset in females were higher than males, but males had more years of education than females. The degree of "stomach pain" in females was more severe than in males, while "trouble sleeping" in males was more severe than that in females. Multiple regression analysis showed that the total Q-LES-Q-SF score was an independent influencing factor of RSS in both males and females, while the total SDS score only affected female RSS.ConclusionsThe prevalence of RSS in FED after acute-phase treatment is high. The symptom of "stomachache" is more pronounced in females, while "trouble sleeping" is more severe in males. Quality of life plays an essential role in RSS in both genders. Thus, sex needs to be considered when assessing the relationship between RSS and therapeutic effect in depression.

The effectiveness of adjunct cryotherapy along with an exercise on somatic symptoms in patients with knee osteoarthritis – a randomized controlled trial

The effectiveness of adjunct cryotherapy along with an exercise on somatic symptoms in patients with knee osteoarthritis – a randomized controlled trial

Health literacy and fatigue, anxiety, depression, and somatic symptoms in patients with differentiated thyroid carcinoma from West China: A cross-sectional study.

Differentiated thyroid carcinoma (DTC) patients are associated with excellent prognosis but impaired health-related quality of life (HRQOL) by initial and subsequent therapy. Health literacy plays a pivotal role in public health and medical settings, but data on its relationship with DTC patients' HRQOL are insufficient and equivocal. This study was designed to explore the relationship between health literacy and HRQOL in patients with DTC from West China areas. A cross-sectional study with a descriptive correlational design was conducted. 126 patients with DTC were recruited between 2020 and 2021. Levels of health literacy and HRQOL (including fatigue level, anxiety/depression status, and somatoform symptoms) were assessed by questionnaires. Pearson product-moment correlation and Stepwise multiple regression were used to examined the adjusted association of health literacy with HRQOL. Health literacy and receiving DTC-related education together explained 16.2% of the variance in fatigue level. Patients who had higher health literacy, received more DTC-related education were currently employed and less fatigue. Health literacy, fatigue level and DTC-related education together explained 31.0% of the variance in anxiety and depression of DTC patients. Patients who had higher health literacy, received more DTC-related education and less fatigue level were less anxious and depressive. Age explained 8.3% of the variance in DTC patients' somatoform symptoms. Older patients complained more somatoform symptoms. Health literacy was positively associated with HRQOL in DTC patients regarding to fatigue level and anxiety/depression status across the entire sample. Interventions to improve HRQOL should take the patients' health literacy into account.

Association of Depressive and Somatic Symptoms with Heart Rate Variability in Patients with Traumatic Brain Injury

Depressive and somatic symptoms are common after traumatic brain injury (TBI). Depression after TBI can relate to worsened cognitive functioning, functional impairment, higher rates of suicide attempts, and larger health care costs. Heart rate variability (HRV) represents the activity of the autonomic nervous system (ANS), which regulates almost all vascular, visceral, and metabolic functions. Several studies show a correlation between HRV, depression, and somatic symptoms in other diseases. However, studies on autonomic dysfunction, depression, and somatic symptoms in TBI patients are lacking. This study investigated the association between reduced ANS function, depression, and somatic symptoms in TBI patients. We retrospectively recruited 136 TBI patients who underwent 24 h ambulatory Holter electrocardiography to measure autonomic dysfunction within 1 month of onset. Patients who used BDI and PHQ-15 to evaluate depressive and somatic symptoms were included. Using Pearson's correlation analysis and multiple linear regression, the association between HRV parameters and BDI and PHQ-15 was determined. The HRV parameters and BDI and PHQ-15 showed statistical significance. In addition, HRV was shown to be a significantly associated factor of BDI and PHQ-15. HRV was associated with depressive and somatic symptom severity in TBI patients. Additionally, autonomic dysfunction may serve as an associated factor of depressive and somatic symptoms in patients with TBI.

Comparison of depressive, anxiety, and somatic symptoms in patients with essential thrombocythemia, polycythemia vera, and myelofibrosis treated with interferon alpha

Introduction: The study aims to analyze the occurrence of depression, anxiety, and somatic symptoms in patients with chronic myeloproliferative neoplasms (essential thrombocythemia, polycythemia vera, and myelofibrosis) and to check whether individual side effects of interferon alpha treatment may contribute to the occurrence of depression, anxiety, and somatic symptoms. In addition, it was decided to check whether there were any relationships between age, gender, duration of treatment, and the intensity of anxiety, divided by the occurrence of individual side effects. Material and methods: The study involved 84 patients and was conducted at the Hematology Clinic of the University Hospital in Krakow and the Clinic of Hematology, Blood Cancer and Bone Marrow Transplantation in Wrocław. The following questionnaires were used: created by the author, David Goldberg General Health Questionnaire 28 (GHQ-28), and the Four-Dimensional Questionnaire (4DSQ). Results: The most frequently reported side effects of treatment were abdominal pain, fatigue, and bone and joint pain. Almost 40% of the respondents obtained a moderately and strongly increased result on the depression scale, less than 50% on the anxiety scale, and over 60% on the somatization scale. Somatic symptoms had the greatest impact on the occurrence of mental disorders, with anxiety symptoms being second in significance. There are differences in the severity of depressive, anxiety, and somatic symptoms depending on the side effects of interferon alpha treatment. Conclusions: The finding of the above study indicates the need for further research into the importance of detecting depressive, anxiety, and somatic disorders, and to addressing concomitant physical symptoms, both in patients with myeloproliferative neoplasms receiving interferon alpha and treated with other methods. In patients treated chronically, the occurrence of side effects of high intensity and lasting for a long time should alert medical personnel. The collected data on patients with myeloproliferative neoplasms who have to suffered from mental and physical symptoms of the disease or its treatment justifies the need for caring psychological, psychiatric, and educational care.

An Evidence-Based Nursing Intervention Decreases Anxiety, Depression, Sleep Quality and Somatic Symptoms of Patients with Acute Ischemic Stroke.

PurposeThis study aimed to explore the effects of evidence-based nursing (EBN) intervention on anxiety, depression, sleep quality and somatic symptoms of patients with acute ischemic stroke (AIS).MethodsThe eligible AIS patients were randomized into the intervention group and control group in a 1:1 ratio. Patients in both groups received routine nursing care. On the basis of routine nursing, patients in the intervention group also received EBN. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), Pittsburgh Sleep Quality Index (PSQI), and the Patient Health Questionnaire-15 (PHQ-15) were used to assess patients’ anxiety, depression, sleep quality, and somatic symptoms at baseline (T0) and 6 months after intervention (T1), respectively.ResultsThere was no difference in SAS, SDS, PSQI, and PHQ-15 scores at T0 between the 2 groups (all P > 0.05). Comparing to the control group, the intervention group had significantly lower SAS and SDS scores at T1 (P = 0.002, P < 0.001, respectively). The SAS and SDS score changes (T1-T0) were more evident in the intervention group than in the control group (all P < 0.001). No difference of PSQI or PHQ-15 score between the 2 groups was observed at T1. However, the PSQI and PHQ-15 score changes were more evident in the intervention group than in the control group (P = 0.044 and P = 0.007, respectively).ConclusionEBN invention significantly improved anxiety, depression, sleep quality and somatic symptoms of patients with AIS.

The central symptoms of depression, anxiety, and somatization: a network analysis

Depression, anxiety and somatization are the most common mental disorders in primary health care. Previous studies have shown that depression, anxiety and somatization are highly comorbid. The study population included 939 depression patients from outpatient and inpatient departments. All patients were assessed with the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the 15-item Patient Health Questionnaire Somatic Symptom Severity Scale (PHQ-15). We estimated the network and centrality of depressive, anxiety and somatic symptoms in patients with depression. Feeling tired or having little energy and feeling down, hopeless were the central symptoms of depression in each network. Low interest or pleasure was not the central symptom. Education was negatively correlated with suicidal ideation. The importance of feeling down, hopeless and fatigue as central symptoms of each network is emphasized. Fatigue symptoms are particularly common in people with depression, and their influence at the center of the depression network may be underestimated. In addition, low interest or pleasure was not the central symptom for each network and education was negatively correlated with suicidal ideation. Highlights Depression, anxiety and somatization are the most common mental disorders in primary health care. This study is the first to explore the network and centrality of depressive, anxiety and somatic symptoms in Chinese patients with depressive disorders. Fatigue and feeling down, hopeless were the central symptoms of depression. Low interest or pleasure was not the central symptom for each network and education was negatively correlated with suicidal ideation.

The Effects of Cognitive Behavioral Therapy with Biofeedback Therapy on the Quality of Life, Anxiety, Depression and Somatic Symptoms in Patients with Dyssynergic Defecation: A Randomized Controlled Trial.

Background: Dyssynergic defecation (DD) is a major cause of chronic functional constipation. Patients with DD have greater psychological distress and impaired health-related quality of life compared with the general population. This study aimed to evaluate the effectiveness of cognitive-behavioral therapy (CBT) combined with biofeedback therapy (BFT) on the quality of life, anxiety, depression and physical symptoms in patients with DD. Methods: This randomized controlled trial (IRCT20141115019957N2) was conducted on 45DD patients who were referred to the Rehabilitation Clinic of Iran University of Medical Sciences in 2017. The convenience sampling method was used to select the participants and then they were randomly allocated into three equal groups using RANDBETWEEN function in Excel. The first group received a combination of BFT&CBT and also standard-of-care therapy (SoCT). The second group was treated with BFT and SoCT, and the third group received only SoCT. The patients were assessed by digital rectal examination and the Short Form-36, Spielberger Anxiety, Beck Depression and Constipation Scoring System questionnaires before and after the treatment.The data were analyzed by SPSS-22, ANOVA, ANCOVA and Chi-Square tests. Results: Patients who received both CBT&BFT had significant improvement in symptoms of constipation, depression, and anxiety.Furthermore, BFT and CBT&BFT groups are valued equivalent only on the mental component of SF36 and the total SF36 questionnaire. But the physical component was significantly different, favoring CBT&BFT (p< 0.001). In CBT&BFT group,67%of patients reached the relaxed stage. In contrast, no patient reached the relaxed neither in BFT nor in SoCT. Conclusion: According to our study, patients with unfavorable responses to BFT may become better if CBT is added to their treatment plan.

Relationships of autonomic dysfunction with disease severity and neuropathic pain features in fibromyalgia: is it really a sympathetically maintained neuropathic pain?

BackgroundThe pathophysiology of fibromyalgia (FM) involves many mechanisms including central nervous system sensitization theory, autonomic nervous system (ANS) dysfunction, and recently small fiber neuropathy. While the small fiber neuropathy itself can cause ANS dysfunction and neuropathic pain (NP), it is still unknown whether ANS problems have an association with severity of disease and NP in patients with FM. The aim of this study was to evaluate ANS dysfunction in FM patients and to explore possible associations of ANS dysfunction with disease severity and NP.MethodsTwenty-nine FM patients and 20 healthy controls were included in this cross-sectional study. Participants were tested using sympathetic skin responses (SSR) and R-R interval variation analyses for sympathetic and parasympathetic ANS dysfunction, respectively. Disease severity and somatic symptoms of patients with FM were evaluated using the ACR-2010 scales and Fibromyalgia Impact Questionnaire, and NP symptoms were evaluated using the Pain Detect Questionnaire and Douleur Neuropathique questionnaire.ResultsFM patients were found to have ANS dysfunction characterized by increased sympathetic response and decreased parasympathetic response. SSR amplitudes were found to be correlated with a more severe disease. Although non-significant, NP severity tended to be associated with a decrease in sympathetic and parasympathetic activities.ConclusionsANS dysfunction may play a role in the pathophysiology of FM. The trend of decreased ANS functions in FM patients exhibiting NP contradicts the notion that FM is a sympathetically maintained NP and may be explained with small fiber involvement.

Biopsychosocial correlates of persistent somatic symptoms in patients with chronic kidney disease – results of the Hamburg City Health Study (HCHS)

Persistent somatic symptoms (PSS) in patients with chronic kidney disease (CKD) are present in all stages and influence the patients' quality of life, morbidity and mortality. Aim of this study was to unravel interactions between biopsychosocial factors and symptom burden in patients with CKD. This cross-sectional study analysed individuals with impaired renal function (GFR <60 mL/min/1,73 m2) out of the first cohort (10,000 individuals) of the epidemiological Hamburg City Health Study (HCHS). As primary outcome somatic symptom burden (PHQ-15) was analysed. As potential correlates, biological (e.g., renal function, comorbidities), psychological (e.g., depression, anxiety, quality of life), and sociodemographic factors were analysed in a multivariate prediction model. Of the cohort, 588 participants (5,9%) had a reduced GFR. Of these, only 159 (27%) were aware of their renal dysfunction. Individuals with reduced GFR reported higher symptom burden compared to healthy controls (mean PHQ-15 (SD): 4,8 (3,9) vs. 5,4 (4,0), p = 0,002, Cohen's d = 0.15). In individuals with reduced kidney function higher symptom burden correlated with reduced GFR ( r = −0.17, p < 0.001). In the multivariate prediction model, GFR was not correlated with symptom burden, which was predicted by depressive symptoms, self-reported coronary heart disease and quality of life. This shows that symptom burden is only marginally related to renal function, while other biopsychosocial factors might play a more important role. Therefore, it is important to take a biopsychosocial perspective on PSS in CKD.

Efficacy and safety of vortioxetine in treatment of patients with major depressive disorder and common co-morbid physical illness

BackgroundThe multimodal antidepressant vortioxetine is effective in reducing somatic symptoms in patients with major depressive disorder (MDD), but little is known about its effects in reducing depressive symptoms in patients with common comorbid physical illnesses. MethodsThis was a pooled analysis of 13 randomized, placebo-controlled trials which evaluated the efficacy (using the Montgomery–Åsberg Depression Rating Scale [MADRS]) and safety of vortioxetine (5-20 mg/day) in adult patients with MDD. We evaluated stable somatic comorbid conditions that were verified by a diagnosis and had sufficient database representation. ResultsOf the 5982 patients included in the database, 963 (16.1%) patients had a diagnosis of cardiovascular disease, 152 (2.5%) had diabetes mellitus and 26 (0.4%) had chronic obstructive pulmonary disorder (COPD). At Week 8, adjusted mean[95%CI] treatment differences (vortioxetine vs. placebo) on MADRS total scores were −2.7[−4.2, −1.3] (p = 0.0002) points for the cardiovascular disease, −4.0[−7.7, −0.4] (p = 0.03) for the diabetes, and −6.2[−21.3, 8.9] (p = 0.36) for the COPD groups. The rate and pattern of adverse events were similar across the sub-groups with comorbidities and was consistent with that expected for vortioxetine treatment. LimitationsThe primary studies were not designed to investigate the relationship between vortioxetine and comorbidities, nor were the post hoc analyses powered to detect group differences. ConclusionsPatients with MDD and comorbid cardiovascular disease or diabetes respond to vortioxetine in a similar way to the broader MDD population. Vortioxetine was generally safe and well tolerated and without unexpected adverse events in these subpopulations, most of whom are taking multiple concomitant medications.